Gastrointestinal illness associated with a long-haul flight

An in-flight incident of vomiting in the cabin and toilet on a trans-Pacific aircraft flight resulted in an outbreak of gastrointestinal (GI) illness among passengers, some of whom subsequently joined a 14-day cruise in New Zealand and Australia. A retrospective cohort analysis of illness occurring in aircraft passengers was undertaken using routine GI illness surveillance data collected by medical staff on a cruise vessel. This was supplemented with data collected from some other passengers and crew on the aircraft. Information was gathered on 224 of the 413 (54.2%) people on the flight (222 passengers and 2 crew members). GI illness within 60 h of arrival in Auckland was reported by 41 of the 122 (33.6%, Fisher's 95% confidence interval 25.3-42.7) passengers seated in the two zones adjacent to the vomiting incident. The pattern of illness suggests a viral infection and highlights the potential of aerosol transmission as well as surface contamination in a closed environment. The spread of infection may have been enhanced by cross-contamination in the toilet cubicle. The significance of the vomiting event was not recognized by the aircraft cabin crew and no pre-arrival information about on-board illness was given to airport health authorities. Isolation of vomiting passengers, where possible, and promotion of appropriate hand hygiene on aircraft has the potential to reduce the spread of infection in passengers on long-haul flights.